The quality of healthcare in the United States is inadequate and inequitable. There is a wide gap between the care people should receive and the care they do receive. Although much of the evidence for substandard quality comes from clinical care for adults, the limited data on children suggest that the quality of their care is comparably lacking. The 2009 Child Health Insurance Program Reauthorization Act (CHIPRA) calls for the establishment of a national Pediatric Quality Measures Program (PQMP) to convene experts, solicit public input, and build infrastructure to provide actionable measures for diverse settings and for a variety of purposes. As part of the PQMP initiative, we propose to establish the Children's Hospital Boston Center of Excellence for Quality Measurement (CoE) to develop, enhance, and test child quality measures, and ensure that they are ready for widespread use. The CoE will be a comprehensive quality measure development center that has the research expertise, clinical experience, and direct access to diverse healthcare delivery models and patient populations that are needed to transform quality measurement. In creating the CoE, we aim to: 1) Build a strong network of academic, clinical, payer, provider, and patient groups that jointly provide exceptional capacity in pediatric quality measure development, testing, implementation, and analysis;2) Develop and enhance pediatric quality measures assigned by AHRQ following a public process;3) Test measures in multiple settings across the clinical spectrum with a wide range of end-users and assure that measures are designed to identify disparities in care;and 4) Deliver to AHRQ actionable measures with detailed specifications that make them ready to use across the health care system. We will lead the development of innovative approaches to improve measurement, testing, and use, drawing on state-of-the-art health information technology (HIT) and statistical methods. We will propose improvements for meaningful use of electronic health records (EHR) and claims systems to enable automated data collection that is valid and reliable across all regions and settings. We will assess patient-level and practice-level disparities in care, and the value and cost-effectiveness of all measures developed. We have capacity in all 5 areas prioritized by CHIPRA for measures development, especially inpatient measures, health outcome measures, and measures of the "most integrated health care settings." PUBLIC HEALTH RELEVANCE: We propose to create the Children's Hospital Boston Center of Excellence for Quality Measurement to develop, enhance, and test pediatric quality measures. We aim to build a strong network of academic, clinical, payer, provider, and patient groups that jointly provide exceptional capacity in pediatric quality measurement. We will assure that measures are designed to identify disparities in care.